Innovation: Ease the pressure
Daniel Hodgkiss, assistant programme manager at Health Innovation West Midlands, says better prevention and identification of health problems in the elderly can lighten the burden on the NHS
It’s no secret that the NHS is operating at full capacity, with increased 999 calls, ambulance conveyances, and hospital admissions, with limited resources to meet demands.
A significant contributory pressure on the NHS comes from care home residents aged over 85, who have varying degrees of frailty, complex healthcare needs, and often have long-term conditions including dementia.
Sadly, care home staff are trying to treat a variety of patients with different issues, which often means deterioration is not identified and timely treatment is not given.
This results in increased pressures on the NHS system, with care home residents making up 8% of admissions to A&E and emergency departments, despite being 2.8% of the overall population. By implementing detection and prevention measures as part of thorough deterioration management processes in care homes, pressures on the NHS from care home residents could be mitigated.
To improve deterioration management processes in care homes, the Health Innovation West Midlands’ (HIWM) Patient Safety Collaborative worked with partners including six integrated care boards across the West Midlands on the ‘Improving Deterioration in Care Homes’ programme. The programme aimed to create long-term and sustainable change across the entire pathway of care, with deterioration networks established at both regional level and Integrated Care System (ICS) level to accelerate learning, share best practices, and roll out a deterioration strategy that was bespoke to each area.
HIWM also supported the creation of a ‘Care Home Deterioration Resource Pack’ for each ICS, developing sustainable training for care home staff, and signposting services specific to each area. In addition, the programme produced a webinar series targeted at care home staff, general practitioners, and advanced nurse practitioners to increase confidence, knowledge, and level of adoption of deterioration tools across pathways.
The project engaged and supported 1,679 care homes, of which 1,431 (85%) adopted deterioration management tools. 919 (55%) care homes continued the use of deterioration tools for upwards of 12 months after the project ended.
Following the programme, HIWM worked with the Midlands and Lancashire Commissioning Support Unit to explore a minimum data set to demonstrate its impact. Between January 2021 and September 2022, there were 2,960 fewer 999 calls, resulting in savings of £19.94 per care home. There were also 42,382 [C1] [LP2] fewer emergency admissions, resulting in a saving of £13,590 per care home, and 36,204 fewer bed days. The modelling report also noted that adopting deterioration management tools within care homes across the six integrated care boards in the West Midlands exhibited a potential non-cash releasing total saving of £15 million.
The programme hasn’t just had positive effects on the NHS; care home managers have also reported staff are more confident in recognising deterioration earlier and can escalate the most appropriate healthcare using the escalation pathways.
One manager explained: “My staff have greatly benefitted from the project – it has improved their knowledge, skill, and confidence in obtaining correct vital signs, understanding the meaning of these vital signs, and be able to act swiftly. Our residents have truly benefitted as we have seen a decrease in hospital admissions, where treatment can be given in the home. Hospital admissions not only cause distress to our residents but their loved ones, so enabling to care for our residents within the home has been a large benefit.”
The results of the programme demonstrate the positive effect detection and prevention measures through deterioration management processes have in mitigating NHS pressure. If the measures explored by the programme were to be implemented nationwide, this would significantly reduce pressures on the NHS, resulting in increased capacity, reduced costs, more available beds and in turn, improved experiences for care home staff and better patient outcomes.
